Please complete all sections. Click the Submit button to continue. Universal Intermodal Credit RequestTerminal* Line Of Credit Requested* Is This For A Broker*- Select -YesNoEmail* Load InformationLoad Date* MM slash DD slash YYYY Load Revenue* Number Of Loads* Per*- Select -DayWeekMonthCommodity* From Company From Location To Company To Location Credit Check Requested ForBusiness Name* Phone*Fax*Broker MC #* DUNS #* Address Line 1* Address Line 2 City* State/Province* Zip* Contact* Federal Tax ID Number* Years In Business* Has the firm or any of its principals ever filed bankruptcy?*- Select -YesNoEDI Capable?*- Select -YesNoEFT Capable?*- Select -YesNoAuto Pay?*- Select -YesNoRequired Customer Documentation For Freight Payment* Bill Of Lading Load / Reference Number Copy Of Permits Copy Of Scale Tickets CommentsReferencesReferences available if requested?*- Select -YesNoCarrier ReferencesName Address Phone Name Address Phone Name Address Phone Bank ReferencesName Address Phone Account Number Contact CAPTCHA
